The Noncommunicable Disease Challenge
The 21st century offers enormous promise with communication, knowledge, and connectedness unlike any time in history. Nonetheless, we all are at increased threats to our health as noncommunicable diseases (NCDs), those mainly due to exposure to risk factors including tobacco and alcohol, poor diets, and limited physical activity, contribute to two thirds of all new cases of premature deaths globally.
Recognizing the challenge to global humankind and prosperity, the United Nations General Assembly (UNGA) unanimously agreed to convene a High-level Meeting on the Prevention and Control of NCDs in September 2011. This is only the second time in history that the UNGA focused an event on health; the first was in 2001 response to the HIV/AIDS epidemic.
As the impact of this challenge has been described by UN Secretary General Ban Ki-moon as a “public health emergency in slow motion,” NCDs increase each day. Today, many effective evidence-based strategies exist for the prevention and treatment of NCDs, but little progress has been achieved by global public health forces in preventing, curbing, or reversing the steady progress of the NCD epidemic into developing countries. Current scenarios indicate that global NCD deaths (now accounting for 60% of all deaths globally) will increase by 17% over the next 10 years with poor and disadvantaged populations disproportionately affected, widening health disparities between and within countries.
In 2011, for example, every day, over 1 billion people smoke or chew tobacco, accounting for one in six of all NCD deaths. Levels of obesity are increasing as they have more than doubled since 1980. Today, more than 1.5 billion adults are overweight, and 43 million children under the age of 5 are overweight. And, a disease like diabetes is increasing to staggering numbers. The global prevalence of diabetes will escalate to 500 million by 2030, from 300 million today. Appropriate health communication about these NCD risk factors has the potential to increase health literacy and promote healthy behaviors with the goal of preventing disease. With the rapid increase in Interactive Communication Technologies, the reach of this communication can be limitless through the use of mobile and digital technology for health.
Given all the challenges in the world—from finance to the environment—the World Economic Forum nonetheless has ranked NCDs above climate change and alongside the global financial crisis in terms of the global risk they pose. The World Economic Forum has dedicated a Global Agenda Council on Chronic Disease and Wellness as an informal advisory group to the World Economic Forum comprised of 15 to 20 relevant experts that represent “the world’s foremost interdisciplinary brain trust of innovative thinking and idea exchange on global issues.” The Chronic Disease Global Agenda Council is chaired by Pan American Health Organization (PAHO) director Mirta Roses Periago, who subsequently has drafted the opening editorial to this issue. Clearly, the NCD threat will require innovative responses and concerted action—both public and private—to reverse the troubling trends and turn the tide toward health and well being.
This special issue of the Journal of Health Communication: International Perspectives entitled “Communicating the Noncommunicable” was born at the World Economic Forum Global Agenda Council on Chronic Disease and Wellness held in Dubai in November 2010. In the development of this journal, many of the authors have engaged in research and dialogue throughout the globe including participation in the UN Interactive Civil Society hearing in the General Assembly in June 2011.
This issue is guest edited by two world experts—Professor Peter Anderson and Dr. Sania Nishtar—both members of the World Economic Forum Global Agenda Council. With a wide range of contributors, the issue hopefully can advance the dialogue with multi-sectoral and pluridisciplinary ideas for the health diplomacy that will be necessary to galvanize political action and policies at the global, regional, national, local, and community level.
Finally, I have been fortunate to have the opportunity to contribute to the global health diplomacy and dialogue on NCDs. I remain convinced that effective and ethical health communication is an important foundation to address NCDs and advance health. It is my hope that this issue and the contributions of the authors will help make the world a better place for all of us to live and prosper with health and happiness.
Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal of Health Communication; International Perspectives and Vice President of Global Health, Johnson & Johnson. He serves on the World Economic Forum Global Agenda Council on Chronic Disease. He also is co-chair of the UN Secretary General’s Innovation Working Group on Women and Children’s Health
Author: Cary L. Cooper
University of Lancaster, UK
Cary L. Cooper, CBE, is Distinguished professor of Organizational Psychology and Health at Lancaster University, England; and Chair of the Academy of Social Sciences (comprised of 41 learned societies of around 87000 social scientists).
The UK Government Office for Science helps to develop evidence-based policy, through their Foresight programme, on a range of topics from infectious diseases to flooding to food security. A couple of years ago they initiated a project to explore mental capital and wellbeing, because the costs of mental ill health were estimated in England alone to be £77b per annum. And with the increasing costs of dementia, currently around £19b, but estimated to grow over the next couple of decades to over £50b because of people living substantially longer (with the doubling of 65 and tripling of 80 year olds over the same period), the overall cost will grow exponentially in most countries.
Mental capital was conceived metaphorically as the bank account of the mind, which is debited or credited throughout the life course, from childhood to old age. The purpose of this major programme was to identify what depletes and what enhances the mental capital, and ultimately the wellbeing of people in early childhood, in their families, in their schools, in their communities, in the workplace and in later life (Beddington, et al, 2008). Over 400 scientists throughout the world were involved in carrying out nearly 90 science reviews (Cooper, et al, 2009), and from that interventions and polices were developed in conjunction with the relevant stakeholders like the major government departments, employer bodies, trade unions, third sector and voluntary bodies, charities and the like. Once the evidence was configured into policy and potential interventions, these were then submitted to a team of economists to carry out cost-benefit analyses, to determine what the return would be for the investment to deal with the particular intervention.
There were a range of proposed interventions and policies, many of which were taken to the appropriate government departments to consider, a number of which were actioned (Foresight, 2008). In terms of early childhood, for example, it was found that roughly 7%-10% of children suffer from dyslexia or dyscalulia (number blindness, ), but if their learning difficulties are not identified early enough, it can adversely affect their wellbeing later in life, which has major costs for government down the line in terms of benefits, the criminal justice system, etc. If we look at the other end of the life cycle, with an aging population in most countries, society will have an enormous bill for the treatment of dementia down the line, unless we can identify the symptoms early enough and provide aids to cognitive enhancement. We provide children with computers in schools for example,e but we don’t provide the elderly with computers so that they can develop social networks with others and keep their cognitive facilities engaged in an effort to stave off dementia.
In the workplace, the science indicates, for example, that how an individual is managed can have a profound effect on mental wellbeing. Those who experience a bullying or autocratic management style can be badly damaged (Einarsen, et al, 2003). Even those who are not bullied but managed by persistent fault-finding rather than by praise and reward regime, can suffer from stress-related outcomes. Yet, there is little training of managers in terms of their social and interpersonal skills, with more emphasis on their knowledge competencies rather than their personal competencies. This can be overcome by government encouraging employers to do the appropriate social skill training, by partnering with companies to jointly fund this kind of training. Another issue that is causing working people problems, is the long working hours cultures in many businesses, with the evidence that if people work consistently long hours it will have negative health impact (Burke & Cooper, 2008). What we need is more flexible working arrangements, which the evidence shows increases job satisfaction, decreases stress levels and increases productivity (although more research is needed in this area). The cost benefit analysis shows that if you introduce the ‘right to request’ flexible working arrangements to all and not just those with children, you will get nearly three times what you invest.
The science reviews, the policies associated with them and the cost benefit analyses can found in Cooper, et al (2009) and in Foresight (2008). This blog is only a taster of some of the ideas that appeared in the largest investigation in the field of mental capital and wellbeing ever undertaken. We must all remember what John Ruskin, the great British social reformer of the 19th Century, “in order that people may be happy in their work, these three things are needed: they must be fit for it, they must not do too much of it, and they must have a sense of success in it”. Gross National Wellbeing, as both Prime Ministers Cameron and President Sarkozy have highlighted, is the challenge for the 21st Century.
Beddington, J., Cooper, et al (2008). Mental wealth of nations. Nature, 455 (23), pp. 1057-1060.
Burke, R. & Cooper, C.L. (2008). The Long Working Hours Culture. Yorkshire: Emerald Publishing.
Cooper, C.L., Field, J., Goswami, U., Jenkins, R., & Sahakian,B. (2009). Mental Capital and Wellbeing. Oxford: Wiley-Blackwell.
Einarsen, S., Hoel, H., Zapf, D. & Cooper, C.L. (2003). Bullying and Emotional Abuse in the Workplace. London: Taylor & Francis.
Foresight (2008). Mental Capital and Wellbeing. London: Government Office of Science, Department of Business, Innovation and Skills).
The Journal of Health Communication is proud to announce the launch of a new blog series. These thought pieces are meant to spark critical thinking on topics in global health communication. The series begins with a group of blogs on Non Communicable Disease (NCDs) in advance of the World Health Organization’s First Global Ministerial Conference on Healthy Lifestyles and Control of Noncommunicable Diseases (NCDs) which takes place on April 28-29, 2011 in Moscow, Russian Federation. The Conference, jointly organized by the Russian Federation and WHO, is a key milestone in the international campaign to curb the impact of cancers, cardiovascular diseases, diabetes and chronic lung diseases.
Author: Zsuzsanna Jakab
Zsuzsanna Jakab is the WHO Regional Director for Europe. A native of Hungary, she was the founding Director of the European Union’s European Centre for Disease Prevention and Control (ECDC) in Stockholm, Sweden, and has served as State Secretary at the Hungarian Ministry of Health, Social and Family Affairs.
Growing evidence is showing that the ‘noncommunicable diseases’ (NCDs) epidemic currently sweeping the world is in fact very communicable and socially determined. These diseases (including heart disease, cancer, diabetes, chronic obstructive pulmonary disorder, and other chronic conditions such as mental illness), which now represent approximately 60% of the global burden of disease and nearly half of all deaths (WHO, 2010), are largely attributable to tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity modified by a number of diverse factors, including environmental components and genetic predisposition as well as health system performance and effectiveness.
On the surface, behavioural choices appear to be individual, yet a wide range of epidemiological evidence conclusively shows that these unhealthy behaviours are predictable and inextricable from the socioeconomic contexts in which they are most commonly found (Kanjilal et al., 2006). Moreover, the World Health Organization (WHO) and other health advocacy groups cite the aggressive global marketing of risky products and behaviours, particularly those targeting children and youth, as key factors in bringing tobacco, alcohol and unhealthy processed foods into households worldwide (WHO, 2010). Of particular concern is the fact that the NCD burden disproportionately affects the most vulnerable communities on the socio-economic ladder, making it a major contributor to growing health inequity worldwide.
As world leaders gear up for the United Nations High-Level Meeting on NCDs, to take place in September 2011, the time is propitious to intensify the debate on strategies for tackling these diseases. Given that chronic diseases are profoundly rooted in social and community ties, a modern communication strategy which unites a wide array of stakeholders will be a linchpin of any successful action to address these public health threats.
Human beings are intensely social animals, and activities such as smoking, drinking, eating, and exercising are often closely associated with group contact. A group of researchers led by Fowler, Christakis, and Rosenquist ( 2008; 2010) have documented this phenomenon using data from the Framingham Heart Study (http://www.framinghamheartstudy.org/), shedding light on how social networks help to determine many health-related behaviours such as tobacco use and alcohol intake and how they disseminate supposedly noncommunicable conditions, including obesity depression, loneliness, happiness and even cooperative social behaviour). Their conclusions indicate that both physical and mental health are strongly influenced by social forces, and that both healthy and unhealthy behaviours spread contagiously in large social groups.
Communication in all its forms – including, education, advocacy, social networking, behavioural counselling and awareness raising – has an unparalleled role in determining population attitudes and beliefs. Communication can influence the public agenda, advocate for policies and programmes, promote positive changes in the social, economic and physical environment, catalyze behavioral changes, stimulate debate and dialogue for health as a priority, and encourage social norms that benefit health and quality of life (UN-ECOSOC, 2010; Wakefield, et al, 2010). A central goal of these strategies must be not only to modify behaviors, but to change the way communities perceive unhealthy behavioral choices, increasing their support for a full range of healthy public policy.
New communication technologies and approaches, when integrated into comprehensive public health strategies, bring this objective within reach; they can effectively disseminate accurate information to virtually everyone; enhance people’s and policy makers’ health literacy related to the four key chronic disease risk factors; and advocate for strong regulations to both enhance access to reliable information as well as counteract the negative influences of the marketing of hazards such as tobacco, alcohol and highly energy-dense foods.
To this end, communication capacity building should include training, twinning, networking and development of tools and guides. Participation should be actively sought from all relevant stakeholders, and the use of information and communication technologies (ICT) and approaches including the use of mobile communications and other social media should be explored to gather evidence on effectiveness. These new approaches are ideal ways for targeting children and adolescents—the generation whose uptake of new media technologies is highest, and also the population group which is arguably most vulnerable to acquiring poor habits. Their choices will have a great impact on development of obesity, diabetes and cardiovascular disease later in life, and thus should be a major objective of health literacy research initiatives and pilot programs which utilize innovative communication tools (UN-ECOSOC, 2010).
Useful approaches need to be shared and adapted. All of these activities could potentially be used to promote and advocate for population and policy maker chronic disease health literacy and enhance the “health literacy friendliness” of the systems in which people obtain and use information. Many sectors and actors can make a substantial contribution to developing health literacy, including education , community-based organizations, scientific societies, and the corporate sector (UN-ECOSOC, 2010). New communication partnerships could provide training at all levels and build sustainable public health communication capacities which could be adapted to the unique needs of different settings.
Communication is one medium by which social norms (and thus many social behaviours) are transmitted; it is also a preeminent tool for fostering wide societal support for comprehensive public health initiatives. In the context of the ongoing technological and communication revolution, health policymakers cannot afford to fall behind in this rapidly evolving field.
Christakis NA & Fowler JH (2008). The collective dynamics of smoking in a large social network. New England Journal of Medicine, 358, 2249–2258.
Fowler JH & Christakis NA (2010). Cooperative behavior cascades in human social networks. Proceedings of the National Academy of Sciences USA, 107, 5334–5338.
Kanjilal S, Gregg EW, Cheng YJ, Zhang P, Nelson DE, Mensah G & Beckles GL (2006). Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among US adults, 1971–2002. Archives of Internal Medicine, 166, 2348–2355.
United Nations Economic and Social Council (UN-ECOSOC) (2010). Health Literacy and the Millennium Development Goals: United Nations Economic and Social Council (ECOSOC) Regional Meeting Background Paper (Abstracted). Journal of Health Communication, 15, 211–223. Retrieved from: http://dx.doi.org/10.1080/10810730.2010.499996.
Wakefield M, Loken B & Hornik R (2010). Use of mass media campaigns to change health behaviour. The Lancet, 376, 1261–1271.
World Health Organization (2009). Public Health Campaigns: getting the message across. Geneva: World Health Organization.
World Health Organization (2010). Background Document – Informal Dialogue with the Private Sector in the preparation of the UN High-Level Meeting of the General Assembly on Noncommunicable Diseases. Geneva: World Health Organization.